ANALYSIS OF REFERRAL LETTERS TO ASSESS THE MANAGEMENT OF POISONOUS SNAKE BITE IN RURAL PAPUA-NEW-GUINEA

A prospective series of patients envenomed after snake bite was seen a t Port Moresby General Hospital (PMGH) Papua New Guinea, between Janua ry 1991 and December 1992. Referral letters were received with 60 of t he patients who had been initially seen at a health centre. These lett ers were analysed in conjunction with our own clinical observations. T he importance of non-clotting blood and local lymphadenopathy as early signs of systemic poisoning did not appear to be universally recogniz ed by staff in health centres. In some cases, no attempt was made to t ransfer the patient to hospital until signs of neurotoxicity were esta blished with potentially dangerous delay. Analysis of both hospital an d health centre records suggests that the majority of deaths which occ urred in Central Province, Papua New Guinea, during the period of the study were due to delay in transfer to hospital. We suggest that all p atients with unequivocal signs of envenoming in Central Province, Papu a New Guinea, should be transfered to PMGH as soon as possible. Antive nom should also be given as soon as possible, but this does not remove the need for immediate transfer.